Department of Biological Sciences
Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/136
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Item Trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone(BioMed Central, 2024-10-02) Osborne, AugustusBACKGROUND: Sierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019. METHODS: The analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. RESULTS: Our findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20-49 had more coverage over time than those with mothers aged 15-19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019. CONCLUSION: The findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone.Item Trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana, 2003–2022(BioMed Central, 2024-11-08) Osborne, AugustusBACKGROUND: Anaemia, characterised by a deficiency in red blood cells or haemoglobin, is a public health issue in Ghana, particularly among children. The prevalence of anaemia in this age group has been a longstanding concern due to its adverse effects on cognitive development, physical growth, and well-being. This study examined the trends and inequalities in anaemia prevalence among children aged 6-59 months in Ghana between 2003 and 2022. METHODS: Data from the Ghana Demographic Health Survey conducted between 2003 and 2022 was used to analyse the prevalence of anaemia in children aged 6-59 months. The World Health Organization's Health Equity Assessment Toolkit software calculated several inequality measures, including difference, ratio, population-attributable risk, and population-attributable percentage. An inequality assessment was performed for six stratifiers: child's age, mother's economic status, maternal educational level, place of residence, child's sex, and sub-national region. RESULTS: Anaemia prevalence among children aged 6-59 months in Ghana declined from 76.1% in 2003 to 48.9% by 2022. The results revealed an age-related inequality in anaemia prevalence among children in Ghana, with younger age group ( 6-11 months) consistently showing higher rates. The age-related inequality Difference was 24.6 percentage points in 2022, indicating that age is crucial to understanding anaemia risk. Economic-related inequality between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) increased from a Difference of 21.1 percentage points in 2003 to 32.7 percentage points in 2022 highlighting the stark inequalities across wealth quintiles. Education inequality between children of mothers with higher education and no education decreased from a Difference of 29.4 percentage points in 2003 to 25.3 percentage points in 2022, suggesting that children from less educated households are still at higher risk. Place of residence inequality between children of mothers living in urban areas and rural areas increased from a Difference of 12.3 percentage points in 2003 to 14.8 percentage points in 2022 reflecting urban-rural disparities. Sex-related inequality between male and female children decreased from a Difference of -0.3 percentage points in 2003 to -5.5 percentage points in 2022 indicating the absence of inequality based on sex of the child. Lastly, regional inequalities are pronounced, as indicated by an increase in the Difference from 21.2 percentage points in 2003 to 34.0 percentage points in 2022, highlighting that children in certain regions like the Northern and Upper East are more affected by anaemia. CONCLUSION: The decline in anaemia prevalence among children aged 6-59 months in Ghana, reflects substantial progress; however, notable inequalities persist across age, economic status, education, place of residence, and region. To address these disparities, strategies such as enhancing access to healthcare services in underserved regions, implementing community education programs to raise awareness about nutrition and health, and promoting economic empowerment initiatives can be effective. Additionally, community education can play a crucial role in offsetting the effects of low household education levels, fostering a more informed population that can advocate for better health practices and policies. By addressing these key areas, we can work towards reducing anaemia prevalence and improving child health outcomes across all populations in Ghana.Item Socioeconomic and geographical inequalities in polio immunisation coverage among two-year-olds in Sierra Leone, 2008–2019(BioMed Central, 2024-12-24) Osborne, AugustusBACKGROUND: Polio, a debeilitating and potentially life-threatening disease, continues to pose a risk to young children globally. While vaccination offers a powerful shield, its reach is not always equal. This study explores socioeconomic and geographical inequalities in polio immunisation coverage among two-year-olds in Sierra Leone between 2008 and 2019. METHODS: The study utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019 to examine polio immunization coverage among two-year-olds. The World Health Organisation Health Equity Assessment Toolkit software calculated various inequality measures, including simple difference, ratio, population-attributable risk, and population-attributable fraction. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. RESULTS: Polio immunization coverage among two-year-olds in Sierra Leone increased from 48.7% in 2008 to 77.1% in 2013, then declined to 61.2% in 2019. No significant inequalities were observed based on maternal age, child's sex or maternal educational level. Coverage was higher among children of mothers from the poorest households, and in rural areas. However, the main inequality identified was subnational inequality. CONCLUSION: The initial increase in coverage followed by a decline underscores the need for sustained efforts to maintain and improve immunization rates, particularly in the Western, Northwestern, and Northern provinces, where significant subnational inequalities exist. The absence of disparities related to maternal age, child sex, and education suggests that traditional demographic factors may not be the primary barriers to immunization; instead, geographic and socioeconomic contexts play a more pivotal role. This indicates that targeted interventions should focus on improving access to vaccination services in underserved areas, potentially through community outreach and mobile vaccination units. Additionally, the better coverage among children of poorer mothers and those in rural areas highlights the importance of understanding local dynamics and leveraging community strengths to enhance immunization uptake.Item Trends and inequalities in stunting and underweight among children aged 0–59 months in Ghana, 1993–2022(BioMed Central, 2025-06-10) Osborne, AugustusBACKGROUND: Stunting and underweight remain significant public health issues in many low- and middle-income countries, including Ghana. This study examined the trends and inequalities in stunting and underweight among children aged 0–59 months in Ghana between 1993 and 2022. METHODS: We utilised data from the Ghana Demographic Health Survey rounds conducted between 1993 and 2022, among mothers of children aged 0–59 months. The World Health Organisation Health Equity Assessment Toolkit software was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAR). An inequality assessment was conducted for six stratifiers: child’s age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. RESULTS: Stunting and underweight prevalence among children aged 0–59 months in Ghana both declined between 1993 and 2022, with stunting decreasing from 32.7 to 17.3% and underweight decreasing from 24.5 to 11.9%. Regarding children’s age, between 1998 and 2022, the difference in stunting prevalence between older children and younger children decreased from -29.5 to -0.9 percentage points, and underweight rates from -10.0 to -2.6 percentage points, indicating reduction in inequality. Economically, the disparity in stunting between children of the richest and poorest mothers declined from 27.2 to 15.3 percentage points, and underweight from 19.6 to 8.3 percentage points by 2022, highlighting reduction in inequality. With educational level, the stunting gap between children of mothers with high and low education reduced from 24.7 in 1993 to 10.5 percentage points in 2022, while underweight decreased from 23.3 to 5.6 percentage points between the same period, suggesting a reduction of inequality in stunting and underweight between of higher educated mothers and those of mothers with no formal education. Regarding place of residence, the difference between children from urban areas and those from rural areas decreased from 15.3 percentage points in 1993 to 4.5 percentage points for stunting in 2022, and from 11.8 percentage points in 1993 to 2.2 percentage points for underweight in 2022, indicating reduction in inequality. Finally, the subnational region difference was 19.1 percentage points for stunting in 2022, and 12.0 percentage points for underweight in 2022, revealing reduced regional disparities in both stunting and underweight rates among regions. CONCLUSION: Our findings on stunting and underweight prevalence among children aged 0–59 months in Ghana from 1993 to 2022 underscore notable progress and persistent inequalities. The inequalities observed across dimensions such as economic status, maternal education, and geographic region indicate the multifaceted nature of stunting and underweight. This situation calls for a continued concerted effort by Government and partner organisations in Ghana to address the underlying socioeconomic determinants of stunting and underweight, aligning with global commitments such as the Sustainable Development Goals.